Treatment of Traveler’s Diarrhea

Traveler’s diarrhea is usually short-lasting (about 3–5 days) and self-limiting. Apart from oral rehydration, no special treatment is necessary for the otherwise healthy traveler. However, in order to avoid a ruined vacation, treatment must provide quick relief from diarrhea and concomitant symptoms. To meet this need, travelers must be equipped with suitable medication for self-treatment. Three options are available. Oral rehydration is harmless but does not significantly shorten the disease, although it prevents complications caused by dehydration and loss of electrolytes. Loperamide is an antimotility agent which significantly shortens diarrhea but will not be a causative treatment, and may even be dangerous if used in cases of potentially invasive diarrhea. Additionally, loperamide can be used only for a short period of time. Antibiotics, which are the only causative treatment option, shorten the duration of symptoms and eliminate the causative bacteria, and are therefore recommended for treatment of moderate and severe traveler’s diarrhea. However, antibiotics often have a negative risk-benefit ratio when weighing potential side effects versus treatment need for a short-lasting and self-limiting disease like traveler’s diarrhea. Azithromycin has several advantages over other antibiotics. It is taken only once (1000 mg), the rate of antimicrobial resistance is low, and it has a good safety profile. Furthermore, in contrast to rifaximin, it can be used in severe cases of diarrhea with fever or bloody stools and can even be administered in children. Optionally, azithromycin can be combined with antimotility medications such as loperamide. Travelers should be reminded that diarrhea can be a symptom of other severe diseases, such as malaria. Therefore, if diarrhea persists or additional symptoms such as fever occur, travelers should seek medical advice.